Cancer and Leukemia Group B Studies in Relapsed AML

  • E. J. Lee
  • P. C. Amrein
  • P. A. Paciucci
  • C. A. Schiffer
Conference paper
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 34)


In the past 20 years, substantial progress has been made in the treatment of acute myeloid leukemia (AML), previously a uniformly fatal diseae. Initial treatment usually consists of a combination of cytosine arabinoside (Ara-C) and daunorubicin, and complete remission (CR) is achieved in approximately 65 % of patients with somewhat higher response rates in younger patients. Once CR is achieved, further chemotherapy is necessary to pro?duce long term disease free survival. How?ever, the majority of patients will relapse; despite the use of these two active drugs as postremission therapy in schedules that have included a 30-fold increase in the dose of Ara-C, there has been, at best, only a modest improvement in survival. Thus, despite 15 year of use of the combination of daunorubicin and Ara-C, the fraction of patients cured with chemotherapy remains in the range 20%–25 % [1–5]. Substantial improvement in long-term disease-free survival has been elusive.


Acute Myeloid Leukemia Complete Remission Complete Remission Rate Postremission Therapy Bone Marrow Aplasia 
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  1. 1.
    Cassileth PA, Begg CB, Silber R, Spiers A, Burkart PT, Scharfman W, Knospe WH, Bennett JM, Mazza JJ, Oken MM, Keller AM, O’Connell MJ (1987) Prolonged unmaintained remission after intensive consolidation therapy in adult acute nonlymphocytic leukemia. Cancer Treat Rep 71: 137–140PubMedGoogle Scholar
  2. 2.
    DutcherJP,Wiernik PH, Markus S,Weinberg V, Schiffer CA, Harwood KV (1989) Intensive maintenance therapy improves survival in adult acute nonlymphocytic leukemia: an eight-year follow-up. Leukemia 2: 413–419Google Scholar
  3. 3.
    Rees JKH, Gray RG, Swirsky D, Hayhoe FGJ (1986) Principal results of the Medical Research Council’s 8th acute myeloid leukemia trial. Lancet II: 1236–1241Google Scholar
  4. 4.
    Schiffer CA, Mayer RJ for the CALGB (1990) Cancer and Leukemia Group B (CALGB) Studies in acute myeloid leukemia. In: Gale RP (ed) Acute myelogenous leukemia: progress and controversies. Wiley/Liss, New York, pp 313Google Scholar
  5. 5.
    Wolff SN, Marion J, Stein RS et al. (1985) High-dose cytosine arabinoside and daunorubicin as consolidation therapy for acute nonlymphocytic leukemia in first remission: a pilot study. Blood 65: 1407–1411PubMedGoogle Scholar
  6. 6.
    Bachur NR, Collins JM, Kelley JA,Van Echo DA, Kaplan RS, Whitacre M (1982) Diaziquone, 2,5-diaziridinyl-3,6-biscarboethoxyamino-1,4-benzoquinone, plasma and cerebrospinal fluid kinetics. Clin Pharmacol Ther 31: 650–655Google Scholar
  7. 7.
    Van Echo DA, Schulman P, Budman DR, Ferrari A, Wiernik PH (1982) A phase I trial of aziridinylbenzoquinone (NSC 182986) in patients with previously treated acute leukemia. Am J Clin Oncol 5: 405–410PubMedCrossRefGoogle Scholar
  8. 8.
    Egorin MJ, Fox BM, Spiegel JF, Gutierrez PL, Friedman RD, Bachur NR (1985) Cellular pharmacology in murine and human leukemic cell lines of diaziquone (NSC 182986). Cancer Res 45: 992–999PubMedGoogle Scholar
  9. 9.
    Lee EJ, Van Echo DA, Egorin MJ, Nayar B, Shulman P, Schiffer C (1986) Diaziquone given as a continuous infusion is an active agent for relapsed adult acute nonlymphocytic leukemia. Blood 67: 182–187PubMedGoogle Scholar
  10. 10.
    Schulman P, Davis R, Lee E, Ellerton J, Staszweski H for the Cancer and Leukemia Group B (1987) Phase II study of continuous-infusion diaziquone in relapsed/refractory acute nonlymphocytic leukemia. Cancer Treat Rep 71: 755–757PubMedGoogle Scholar
  11. 11.
    Schiffer CA, Davis RB, Mayer RJ, Peterson BA, Lee EJ (1987) Combination chemotherapy with diaziquone and amsacrine in relapsed and refractory acute nonlymphocytic leukemia: a Cancer and Leukemia Group B study. Cancer Treat Rep 71: 879–880PubMedGoogle Scholar
  12. 12.
    Lee EJ, Reck K, Schiffer C (1990) Continuous infusion diaziquone and etoposide: a phase I study in adult patients with acute leukemia. Leukemia 4: 189–192PubMedGoogle Scholar
  13. 13.
    Paciucci PA, Davis RB, Holland JF et al. (1990) Mitoxantrone and constant infusion etoposide for relapsed and refractory acute myelocytic leukemia. Am J Clin Oncol 13: 516–519PubMedCrossRefGoogle Scholar
  14. 14.
    Amrein PC, Davis RB, Mayer RJ, Schiffer CA (1990) Treatment of relapsed and refractory acute myeloid leukemia with diaziquone and mitoxantrone: a CALGB phase I study. Am J Hematol 35: 80–83PubMedCrossRefGoogle Scholar
  15. 15.
    Lee EJ, Paciucci A, Amrein P, Schulman P, Davis R, Schiffer CA (1990) A randomized phase II trial of three regimens in the treatment of relapsed or refractory acute myeloid leukemia (AML) in adults: a CALGB study. Blood 76 [Suppl]: 294aGoogle Scholar
  16. 16.
    Brown RA, Herzig RH,Wolff SN, Frei-Lahr D, Pineiro L, Bolwell BJ, Lowder JN, Harden EA, Hande KR, Herzig GP (1990) High-dose etoposide and cyclophosphamide without bone marrow transplantation for resistant hematologic malignancy. Blood 76: 473–479Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • E. J. Lee
    • 1
  • P. C. Amrein
    • 1
  • P. A. Paciucci
    • 1
  • C. A. Schiffer
    • 1
  1. 1.University of Maryland Cancer CenterBaltimoreUSA

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